More short-term stays the biggest factor fueling the increase
By Steven Reinberg
MONDAY, Aug. 28, 2017 (HealthDay News) -- More than half of Americans will find themselves in a nursing home at some point in their lives, a new study shows.
That eclipses the 35 percent estimate used by the U.S. Department of Health and Human Services, the researchers added.
"Lifetime use of nursing homes is considerably greater than previously thought, mostly due to an increase in short stays of less than three weeks," said lead researcher Michael Hurd. He is director of the RAND Center for the Study of Aging, in Santa Monica, Calif.
Increased nursing home care begs the question of who will pay for it and how will they pay for it, he said.
"Out-of-pocket spending is not particularly large, on average, but the risk of long stays and of correspondingly large out-of-pocket spending is fairly large -- 5 percent of patients will spend more than 1,500 days in a nursing home, and 5 percent will spend more than $50,000," Hurd said.
For married couples, the financial risks are even larger, he noted. As baby boomers start needing more nursing home care, costs will be staggering.
"Families need to take this into account for financial planning, and society needs to be prepared to assist families that cannot finance nursing home stays," Hurd said.
The report was published online Aug. 28 in the Proceedings of the National Academy of Sciences.
One long-term care expert pointed to the driving forces behind the trend.
"An aging population, earlier discharges from hospitals to nursing homes for rehabilitation, higher incidences of dementia [all mean] that the risk of a stay in a nursing home is more likely for individuals," said Lori Smetanka. She is executive director of the National Consumer Voice for Quality Long-Term Care, in Washington, D.C.
With the costs of long-term care and services growing, most people and families will rely on programs such as Medicare and Medicaid, she said.
For the study, Hurd and colleagues analyzed 18 years of data from the Health and Retirement Study, which is a project sponsored by the U.S. National Institute on Aging and the U.S. Social Security Administration.
The investigators found that most Americans will be able to afford brief nursing home care with out-of-pocket costs of about $7,300. About one-third of adults between 57 and 61 will spend money on nursing home care, and 43 percent will have their care completely covered by private or public insurance, Hurd said.
Most people will have short stays in nursing homes at a relatively affordable cost, he noted.
Overall, the average nursing home stay was 272 nights, but for 10 percent the stay was more than 1,000 nights, the findings showed.
But for the 5 percent of older adults who needed long stays, out-of-pocket costs were $47,000 or more, the researchers found.
The shift toward shorter nursing home stays may account for higher estimates of nursing home use, Hurd said.
Nursing home stays of 21 nights or less rose from 28 percent in 1998 to nearly 34 percent in 2010, the researchers found.
The increase in shorter stays may be due to efforts to control Medicare and Medicaid costs by discharging patients from hospitals to nursing homes, where rehabilitation costs are lower, Hurd suggested.
Whether it's worth buying insurance to cover long-term care isn't clear, he noted.
Only 11 percent or 12 percent of people in their early 60s uses long-term care insurance, he said. Questions about what that insurance will pay for makes the buying of long-term health insurance iffy, Hurd explained.
People might be better off relying on Medicaid, he said. "It's the best of a not-very-good situation," Hurd added.
Although your children may not reduce the odds of your having to go to a nursing home in old age, Hurd said, their care of you may cut the length of your stay and its costs by about 38 percent.
If you have daughters who can provide in-home care, you can save even more money, he said.
"In addition to costs, individuals and family should also consider the quality of care and services provided by nursing homes," Smetanka said.
Visiting facilities in advance, asking questions, particularly about the number of staff available to provide care and observing the interactions between staff and residents, is an important way to get a clear picture of what life would be like in a nursing home, she suggested.
Dr. David Katz, president of the American College of Lifestyle Medicine, said that the best way to reduce the need for a nursing home stay is to live a healthy lifestyle that will reduce your risk of the chronic diseases that result in the need for nursing home care.
"We are increasingly prone to nursing home stays here in the U.S. because medical advances promote longer life, but we lack the corresponding cultural commitments to promoting better health," he said.
Visit Medicare for more on nursing homes.
SOURCES: Michael Hurd, Ph.D., director, RAND Center for the Study of Aging, RAND Corp., Santa Monica, Calif; Lori Smetanka, executive director, National Consumer Voice for Quality Long-Term Care, Washington, D.C.; David Katz, M.D., M.P.H., director, Yale-Griffin Prevention Research Center, Derby, Conn., and president, American College of Lifestyle Medicine; Aug. 28, 2017, Proceedings of the National Academy of Sciences
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